| NPI | 1982634549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A76395) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 95776) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2023-03-16 |